peri-implantitis treatment with chitosan brush

Conditions: Peri-implantitis

Summary: in dentistry, dental implant applications for tooth loss/deficiency are prominent and provide successful long-term results in terms of functionality and aesthetics. however, peri-implant diseases such as peri-implant mucositis and peri-implantitis may develop due to biofilm accumulation around the implant. in peri-implantitis, in addition to the clinical inflammation findings seen in peri-implant mucositis, there is also progressive bone loss. this condition is to be treated with non-surgical or surgical methods. titanium curettes, ultrasonic instruments, laser systems, and chitosan brushes are used for biofilm removal in non-surgical treatment. chitosan is a natural polysaccharide obtained from chitin. it is biocompatible, biodegradable, and has antibacterial activity. in addition, chitosan reduces the levels of il-1β, il-6, and tnf-α, which also play a role in the pathogenesis of peri-implantitis, and exhibits anti-inflammatory effects on macrophages activated by lipopolysaccharide. although many methods are used to treat peri-implantitis, successful and predictable results cannot be obtained. this study aims to examine the clinical and immunological findings and observe the changes in the non-surgical treatment of peri-implantitis using chitosan brush or titanium curette over 12 months. sixty dental implants diagnosed with peri-implantitis clinically and radiographically at the department of periodontics, faculty of dentistry, hacettepe university will be included in the study. non-surgical peri-implantitis treatment of these patients will be performed using a chitosan brush (n=30, case group) or titanium curette (n=30, control group). pre-operative and post-operative 3rd, 6th, and 12th months, clinical periodontal indices will be recorded, peri-implant crevicular fluid (pif) will be collected, and maintenance treatment will be applied to the patients. il-1β, tnf-α, il-8, il-10, and il-17 levels in the collected pif will be determined by the elisa method. the effectiveness of chitosan brush and titanium curette in treating peri-implantitis will be evaluated and compared clinically and immunologically.


Eligibility criteria:
inclusion criteria: * presence of peri-implantitis in an implant that has been in function for more than 12 months * age ≥ 18 and \< 65 * agreeing to participate in the study after reading the informed consent form * completion of periodontal treatment of patients diagnosed with periodontitis before inclusion in the study exclusion criteria: * patients under 18 years of age * patients who have received or are currently receiving radiotherapy, chemotherapy and long-term systemic corticosteroid treatment * patients who received systemic antibiotics within 6 months from baseline * pregnant or lactating patients * patients with anatomical abnormalities around the implant (e.g., apically positioned implants adjacent to a tooth) * patients with prostheses that prevent access for implant debridement with chitosan brushes or titanium curettes * implants with an overdenture superstructure * implants to be explanted * patients with asa score ≥ 3 * patients reporting reactions or adverse events to chitosan, stainless steel, adhesives, or polypropylene * clinically mobile implants * recently placed and non-osseointegrated implants * around major nerves and blood vessels, if there is a risk of structural damage

Keywords: chitosan brush non-surgical peri-implantitis treatment peri-implantitis cytokine titanium curette